"They don't care about us..."

"They don't care about us...the paramedics take 20 minutes to get here, and they're just up the street...if this were 'Rich City America', they'd have been here by now..."

Anyone who works, lives, or otherwise visits the hood, has probably heard this before. Perhaps even experienced it. I've seen people get shot, 911 called...and, after 20 minutes bystanders/friends/whomever decide to just load the victim up into someone's truck and drive them to the nearest ER (nevermind it's not a trauma center...and bringing a trauma patient to a non-trauma ED is probably worse than just letting them sit on the street corner waiting...). This is the way my own father died, actually. So, I do know.

My sister was at In-N-Out one day. And a lady fell down seizing in the parking lot. Bystanders, including my sister, decided to 'help out'. She called me from her cell. "Sister, there's this lady here, I think she's having a seizure because she not responsive and she's shaking...what should we do?"

My first question is "Do you know her?"

Sister: "no."

So (I think to myself), let me make sure I'm understanding the situation correctly: some random lady 'fell out' in the hood somewhere...and you're calling *me* for medical advice?

My advice..."call 911."

Sister: "We called them 15 minutes ago...and no sign of help. Typical. If we lived in 'Rich City America' they'd be here by now. Why do they take so long on this side of the city?

I'll tell you why. Over there, people tend to...(how can I say this tactfully?)...be less concerned about others. They're about "getting rich, or die tryin." Nevermind what this does to the community. And 'the community' doesn't hold it's own accountable...(but that's a rant for another day).

Anyway...let me tell you what was (hypothetically) happening during that same timeframe, while my sister waited for an ambulance, with a random lady in the parking lot...

The players:
There's a guy named Bob, who frequents the ER at the Kingdom. He comes up with various complaints depending on the day. He lives in the ER waiting room, all of his 'stuff' is there. His basket, his bags, his trash. He'll sleep on the floor, in the corner at night. But in the day, security makes him leave 'unless he wants to see the doctor.' Well, if it's cold, or raining...or if he's just hungry, he'll make up a chief complaint...so he can 'wait and see the doctor.' The wait times at King are typically 12-14 hours...so he's good all day. But, at some point, he does get back to see us. And after running thousands of dollars worth of unnecessary tests (at your expense), he is discharged back to the street.

He goes outside...it's still cold...he turns around and checks in again. "I need to see the doctor."

After this happens a few times...he is not allowed to come back in (and, yes, he just might die of something totally random and unrelated, of course it'll make news...and everyone will think that the triage nurses are heartless..."how could this 'poor guy' not be allowed into the ER to see a doctor" and so forth and so on...). So, he goes to Burger King across the street, and calls 911. They dispatch a full response...and homeless dude is brought back to our ED. But...there are no ED gurneys. So the paramedics have to sit...and wait. 'Ambulance crews have waited for as long as 5 1/2 hours to transfer patients to the care of emergency-room staff.'

Then there's the very young mother and her 6 month old son. She calls 911 from her project across the street because she (and I quote) "doesn't want to wait" in the waiting room. The firefighter/paramedic brings the patient straight back, "This is a healthy 6 month old boy who, according to mom, hasn't slept in 4 hours" they report.

I look down on the gurney. In the infant carrier is a healthy looking *sleeping* baby (with 2 large fake diamond stud earrings, and a gold chain around his neck that reads "Lil'bit"). I look at the firefighter, he shrugs and says "baby has been sleeping the entire time." I then look at this mother, confused. She says "I just wanted to get him checked out." I cringe, and try to silence the little voice in my mind that is chanting "PLEASE. CHOKE. HER."

So...I send her, and her baby, out to the waiting room. Just because you come in by EMS, doesn't mean you're the sickest person waiting. Also, why keep this paramedic crew tied up for a healthy baby? She's upset..."I didn't call 911 to wait. This isn't fair, I hate this hospital..."

She storms out of the ER, pissed because she couldn't just...have things her way (I'm sure she filed a complaint with admin that will result in a 'conference', and 4 hours of "sensitivity training"). She left the ER, and got into her baby daddy's car...the car that followed the paramedics to the hospital from across the street.

Then, there's the pissed off wife, who calls 911 everytime her husband gets drunk...so she doesn't have to deal with him. "but he passed out." Yeah...that's what drunks do. How else would they ever stop drinking?

Then there's the family who dumps 'Mama' in the ER everytime they all want to go out and see a movie. "I think her sugar is acting up again" they say as they push her wheelchair thru the back door, and promptly disappear.

Then there's the drunk that the cops keep bringing in.
"Why can't you guys just take him to jail?"
They say, "Because he might have something else wrong with him."
I say, that's the price you pay when you get drunk in public, and piss on someone elses front porch. You go to jail with a the potential of having "something else" wrong with you that no one figures out until you sober up.

Or the felon who cries "chestpain" when he gets caught robbing a liquor store. Apparently they can't just take people to jail...taxpayers have to provide a full physical examination in the ED...and we have to sign a form as doctors saying "it's okay to book this patient." As if, in 1-2 hours we can determine if this guy is indeed "okay." As if, a 'normal' person would be allowed a 12 hour ER stay, food and a show, at someone else's expense...if they did something that required them to be "booked." I guess we should all learn that making up a "medical illness" may be worthwhile if we face the prospect of serving jail time (just ask Ms. Paris Hilton).

All ER docs are sure to have examples of blatant abuse of emergency services that society pays so dearly for.

Because of this very inappropriate use of the ED (some understandable, most not), we have no beds...no nursing...no resources to deal with emergencies. Paramedics have no place to drop off sick patients, so they sit at King for hours. Then, when the local EMS team is at 'the young mothers' place, cuz 'she doesn't want to wait,' ....a person with a *real* emergency has no EMS nearby available to respond.

Understand, that the little firehouse on the corner...depending on the area of the city...has no firefighters in it. They are at King, or in the adjacent city 'helping' those communities with their EMS needs. Afterall, we (the dispatcher, the medics) can't just tell people "no, you don't need a paramedic, we're not going to transfer you to the hospital". So, EMS brings us all this bullshit. Bullshit, that shouldn't have passed 'GO.' Bullshit that clogs our system. Bullshit that prevents us from identifying and treating true emergencies. We, as a society, do not hold people accountable (in any way) for calling EMS, for inappropriate use of social services. If there were some consequences...perhaps the right/privilege (however you see it) to utilize the ER...maybe things would be a bit better.

Getting back to the In-N-Out in on the 'wrong side of town'. 911 was called. The closest firehouse was empty as described. The next closest team is on the freeway, on it's way to the nearest open ER (transporting homeless dude)...which is 15 miles away. The next closest firehouse is...in the next city. It takes 30 minutes for them to reach the seizing woman. Where there is a high incidence of inappropriate use of resources...the ERs are more likely to be at capacity.... and, in turn there are no available resources for the average (good) citizen (or non-citizen). And it seems as if.....*they* don't care about folks unless they live in 'Rich City America'.

But, wait time to paramedic arrival is only the outcome of a complicated problem that disproportionally affects cities (or parts of the city) where there's a higher percentage of poverty.


Rory said...

amazing post. keep up the good work. ems needs 2 things... better education, and more docs like you.

wealthandtaste, medic.

Doc Yuki said...

I agree with rory.

Reading that, I feel such a sense of hopelessness. So many problems, inadequacies, injustices, stupid people.

All I can think is, "what do you do?" When faced with such heart-breaking problems. But then again, that's the way the "hood" is I suppose.

They really don't care about anything - welcome to the human condition.

ERnursey said...

Sad but true. I see it every day.

ERMurse said...

The urban ER that I have worked at solevd much of the abuse by triaging the ambulance abusers to the waiting room. We freed up the paramedics right away. The means of arrival did not give one any special status in line, the triage assessment did. I have even had people leave out the ER and go call the ambulance and guess what, if indicated, they got triaged right back to the waiting room.

The Angry Medic said...

Wow. I just came across your blog and couldn't help but read through the whole front page in one sitting. Thanks for linking to me. Your posts are compelling and literally have me staring at my screen slackjawed, slowly munching popcorn like some couch potato.

It's great to hear the other side of the story for once. And I'm glad hospitals like ERMursey's do what they do; I'd push very hard to do the same. Rory's right: EMS needs more docs like you.

I'm adding you to my blogroll pronto. Hope you don't mind the heading I've given you :)

KC Saul said...

You know, maybe someone should take a reporter on a ride-along with the local EMS service. Seriously.

Nurse K, Generic ER Nurse said...

Our medic companies complain if they have to wait like 2 minutes for someone to arrive and take their patient. Like, literally 2 minutes. The travel nurses who've worked in California or Phoenix or Florida just laugh that we run towards all the ambuli with non-critical patients.

They also complain/argue if I send an ambulance abuser or someone with a real, non-urgent problem to triage. There are 10 other psych patients in the lobby and yours is walking in; she can go to triage like the rest of them. Then they argue, argue, argue. "She's suicidal." So is everyone else in the lobby.

I don't think medics get the whole idea of triage and that if we take this patient right away who isn't sick, the appy in the lobby who's been waiting 2 hrs won't get back.

KC Saul said...

Nurse K, You might want to triage your suicidal patients. If they have an actual specific plan and are not merely being a melodramatic frequent flier, and you make them wait in the ER til they go away, they just may. Permanently.

Nurse K, Generic ER Nurse said...

...you make them wait in the ER til they go away, they just may.

You think I'm dumber than a bag 'o hammers or something? Suicidal people brought in by the medics are on a hold and are watched by security in the lobby constantly. They are triaged by the triage nurse just like everyone else. The 2 measley psych rooms are always full, and the social workers will evaluate them in the lobby too, if necessary. Generally, the psych patients all sit together either in a special room or within a few feet of the guard.

Thomas said...

Yes, doctor, that's it, I don't know why it took me so long to see it. People in the 'hood' are there because don't care about themselves. Yet, despite their lack of care, they influence their city government to misuse all 'their' resources, because they don't care. and are wasteful. probably illiterate, too. In other words, dumb-ass poor blacks and mexicans, too busy eating fried chicken and smoking crack before fucking someone with a fucked-up name (I don't actually know any black people NOT named shatiqua) to 'care about themselves'.
Nice doc. Right on, A-plus diagnosis.

Since 'hood' - and you mean black - communities won't do it themselves, because of course they can, you know, drug-dealers and users always listen to pastors and other responsible citizens, yeah... you've got a better solution: penalization. Great, doc.
The poor are only poor becasue their lazy fuckers who don't have the gumption to pull themselves up by the bootstraps.

Why don't you just call them niggers and get it over with?

ER doctor said...

Thomas, you sound racist.

Thomas said...

Yes. I'm racist. That's it doc. I wasn't being flippant in the slightest...
What's racist is the idea of penalizing people for misusing public services when there is only one sector of society, comprised almost entirely of minorities, that is left uneducated enough (by our society) to actually do so with any frequency. It's called instituational racism, and it's perpetuated by the use of penalization without coresponding efforts toward education.

Yes, I used the word 'nigger' which is a very bad word that we are not supposed to say ever, which instead of saying we engrave in our institutions in language much more subtle and much more devious.
I used the word 'Nigger' doc, which makes me sound like a racist.
But it's you, writing off an entire sector of society as you do in the closing paragraphs of your post, that's actually being racist.

eda said...


HACKER said...

Reading that, I feel such a sense of hopelessness. So many problems, inadequacies, injustices, stupid people.

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